need for alternative solutions when caring for patients with language barriers

Barriers to quality communication increase the risk for misunderstanding, negatively impact the thoroughness of health investigations, and can lead to delayed diagnoses and increased readmissions. In addition, language barriers disproportionately affect the most vulnerable populations; thus, a lack of appropriate interpretation services promotes health disparities and increases the vulnerability of the underserved minority populations. According to the Act Respecting Health Services and Social Services of Quebec, health organizations need to take into account the distinctive linguistic and sociocultural characteristics of each region and, “foster […] access to health services and social services through adapted means of communication for persons with functional limitations”. A language barrier is a form of functional limitation that patients face when accessing healthcare services. Despite a clear policy, the current use of professional interpretation services is limited in our healthcare facilities, thus increasing obstacles in accessing healthcare services for patients with language barriers. It is thought that by identifying how language barriers present in our healthcare system and by highlighting the tools available to mitigate their consequences, healthcare workers, including medical students, may be better placed to serve the non-French and non-English speaking community. A group of medical students from the Universities of Montreal and McGill who are part of MedComm researched the problematic, most specifically in Montreal, in the hopes of emphasizing the need for alternative solutions to the current state of affairs in regard to offering optimal care to patients with language barriers.

Assessing the relationship between measures of healthcare access and functional limitations among individuals with Chronic Obstructive Pulmonary Disease (COPD)

Objectives: Functional limitation from COPD manifests more from physical rather than respiratory impairment. To what extent health access affects the functional limitation among individuals with COPD is yet to be known. This study aims to assess the relationship between healthcare access and functional limitations among individuals with COPD. Study Design: Retrospective analysis of a cross-sectional population-based survey Methods: This study pooled 11 years of (2008 to 2018) data from the Integrated Public Use Microdata Series, National Health Interview Survey (IPUMS NHIS). We restricted the data to respondents with self reported COPD, aged 40 years and older. The independent variables were sociodemographic and behavioral characteristics. The exploratory variables were measures of healthcare access ( healthcare coverage, delayed appointment, affordable care, and a usual place for care). The outcome variable was the presence or absence of functional limitations. Results: The age, race, educational attainment, marital status, smoking status, and poverty income ratio had a significant association with functional limitation (p<0.001) We found statistically significant associations between functional limitation and healthcare coverage, delayed appointment, affordable care, and a usual place for care. Poverty modified the relationship between functional limitations and the four measures of healthcare access, with the odds of functional limitation increased among the poor with no healthcare coverage, delayed appointment, unaffordable care, and no usual place for care. Conclusions: A strong relationship exists between the quartet of healthcare coverage, delayed appointment, affordable care, and usual place for care and self reported functional limitation among individuals with COPD. Poverty was an effect modifier, with the odds of functional limitation worse among the poor.

On the measurement of healthy lifespan inequality

Background Current measures to monitor population health include indicators of (i) average length-of-life (life expectancy), (ii) average length-of-life spent in good health (health expectancy), and (iii) variability in length-of-life (lifespan inequality). What is lacking is an indicator measuring the extent to which healthy lifespans are unequally distributed across individuals (the so-called ‘healthy lifespan inequality’ indicators). Methods We combine information on age-specific survival with the prevalence of functional limitation or disability in Spain (2014–2017) by sex and level of education to estimate age-at-disability onset distributions. Age-, sex- and education-specific prevalence rates of adult individuals’ daily activities limitations were based on the GALI index derived from Spanish National Health Surveys held in 2014 and 2017. We measured inequality using the Gini index. Results In contemporary Spain, education differences in health expectancy are substantial and greatly exceed differences in life expectancy. The female advantage in life expectancy disappears when considering health expectancy indicators, both overall and across education groups. The highly educated exhibit lower levels of lifespan inequality, and lifespan inequality is systematically higher among men. Our new healthy lifespan inequality indicators suggest that the variability in the ages at which physical daily activity limitations start are substantially larger than the variability in the ages at which individuals die. Healthy lifespan inequality tends to decrease with increasing educational attainment, both for women and for men. The variability in ages at which physical limitations start is slightly higher for women than for men. Conclusions The suggested indicators uncover new layers of health inequality that are not traceable with currently existing approaches. Low-educated individuals tend to not only die earlier and spend a shorter portion of their lives in good health than their highly educated counterparts, but also face greater variation in the eventual time of death and in the age at which they cease enjoying good health—a multiple burden of inequality that should be taken into consideration when evaluating the performance of public health systems and in the elaboration of realistic working-life extension plans and the design of equitable pension reforms.

Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled

Clavicle fractures are commonly seen in the pediatric and adolescent populations. In contrast, congenital pseudarthrosis of the clavicle is rare. Although both conditions may present with similar signs and symptoms, especially in the very young, clear differences exist. Clavicle fractures are often caused by trauma and are tender on palpation, while pseudarthrosis often presents with a painless protuberance on the clavicle, which becomes more prominent as the child grows. Its presence may only become apparent after trauma, as it is usually asymptomatic. The diagnosis is confirmed on plain radiography, which shows typical features to distinguish both entities. Both clavicle fractures and congenital pseudarthrosis are generally treated conservatively with a high success rate. Operative treatment for a fracture can be indicated in the case of an open fracture, severely displaced fracture, floating shoulder, neurovascular complications or polytrauma. Congenital pseudarthrosis requires operative treatment if the patient experiences progressive pain, functional limitation and late-onset thoracic outlet symptoms, but most operations are performed due to esthetic complaints.

Prevalence of partial edentulism among the patients visiting a Tertiary Health Care Center in the Western Region, Nepal

Introduction: Tooth loss causes impairment, functional limitation, physical, psychological, and social disability. Hence, the study of pattern of tooth loss can provide a rough information about the frequency, cause and magnitude of oral problems, its sequelae that eventually can act as mirror image of prosthodontic treatment needs. Objectives: To assess the prevalence of partial edentulism and its etiology, to determine its association with sociodemographic parameters, and to find out the motivational factor/s for replacement in willing patients. Methods: Total 417 patients with partial edentulism were examined intraorally on the basis of Kennedy’s classification with Applegate’s modification. The descriptive analysis was done using frequency distribution. Pearson Chi-square analysis test was used to determine the association between demographic variables and type of tooth loss where p-value ≤0.05 was considered statistically significant. Results: Partial edentulism was more prevalent in mandibular arch (41.7%) followed by both arches (30.9%). Kennedy’s Class III was the commonest and Kennedy’s class III modification 1 was second most common type of partial edentulism. Age and educational status had statistically significant association while gender had no association with various classes of partial edentulism. Dental caries (62.8%) followed by periodontitis (25.9%) were the major causes of tooth loss. Functional demand (46.8%) was the key motivational factor for the replacement among those who were willing (78.4%). Conclusions: This study can help in assessing the epidemiological features of partial edentulism of one community in a more classified form and can help gather information necessary to assess the treatment needs.

Knee joint dislocation: overview and current concepts

Knee joint dislocation is a relatively uncommon injury but its management is important because of the associated high risk of vascular, neurological and multi-ligamentous knee injuries. Clinicians must be aware that not all knee dislocations are diagnosed on plain X-rays; a high index of suspicion is required based on clinical evaluation. Multidisciplinary specialist care is required in all cases to achieve best outcomes. Early one-stage or multiple staged ligament repair and reconstruction offer better outcomes, but most patients have some long-term functional limitation. This article provides insights into the epidemiology and management of this injury and its devastating effects.

Understanding the Disease Burden of Unemployed Patients with Axial Spondyloarthritis. Results of the Spanish Atlas 2017

Objective To evaluate differences in sociodemographic factors and patient-reported outcomes (PROs) between unemployed and employed axSpA patients and to explore work-related issues. Methods Data through online survey from 680 unselected patients of the Spanish Atlas of Axial Spondyloarthritis were analysed in 2017. Active workforce participants were divided into employed and unemployed according to International Labour Organization standards. Sociodemographic characteristics, PROs [BASDAI (0-10), spinal stiffness (3- 12), functional limitation (0-54), and psychological distress through General Health Questionnaire GHQ-12 (0-12)] were assessed. Logistic regression analysis was used to evaluate the association with unemployment status. Results 415 (63.6%) patients were categorised in the active population, of which 325 (78.3%) were employed and 90 (21.7%) unemployed. 62.8% (N = 54) of unemployed declared that their joblessness was due to axSpA. Of the employed, 170 (54.3%) reported work-related issues in the year prior to the survey, being the most frequent "difficulty fulfilling working hours" (44.1%), "missing work for doctor appointments" (42.9%), and "taking sick leave" (37.1%). Being unemployed was associated with lower educational level (OR= 2.92), disease activity (OR= 1.37), spinal stiffness (OR= 1.21), functional limitation (OR= 1.05), worse mental health (OR= 1.15), anxiety (OR= 2.02) and depression (OR= 2.69) in the univariable models; and only with lower educational level (OR= 2.76) and worse mental health (OR= 1.15) in the multivariable. Conclusion Results show significant differences between employed and unemployed axSpA patients. Employed axSpA patients endure many problems at work related to their condition, though unemployed patients present worse disease outcomes associated with greater psychological distress.

Prevalence of Musculo-skeletal Discomfort and Level of Functional Limitations among Physiotherapists in Karachi City

Introduction: Musculoskeletal discomfort is one of the most prevalent muscular pain condition hindering normal activities reported by physical therapists and health care professionals generally engaged in handling and mobilizing patients. The study was conducted to find the prevalence of musculoskeletal discomfort and level of functional limitations in physiotherapists. Method: This research was questionnaire based cross sectional study conducted in Karachi city from January to April 2019.Data collection was completed from registered physical therapists employed in different institutions. Two questionnaires were filled by the physiotherapists. Questionnaire 01, including thirteen questions on functional activities of daily life which are potentially related to functional areas of Neck Disability Index (NDI). Questionnaire 02 was based on 1987 version of Nordic musculoskeletal questionnaire. Results: Participation of 80 physical therapists in the study.75% was directly involved with patient handling and 25% were teachers. A total of 35% therapists reported 7 days symptoms prevalence with a higher prevalence in cervical (77.1%), lower back (68.6%) and upper back (51.4%).Similarly 65% workers showed previous 12 month symptoms with higher prevalence in neck (72.3%). Gender prevalence of 7days and 12 months was high in female therapist. Conclusion: It has been concluded that 12 month prevalence of musculoskeletal discomfort was 65%, whereas 7 days was 35% and level of functional limitation from activities was insignificant. Keywords: Epidemiology, musculoskeletal discomfort, Severity, Physical therapy,

587 Exercise induced pulmonary hypertension in hypertrophic cardiomyopathy: a combined cardiopulmonary exercise test-echocardiographic study

Aims Pulmonary arterial hypertension (PAH) has been described in patients with hypertrophic cardiomyopathy (HCM) and it was associated with a worse prognosis. Nevertheless in most HCM patients, despite normal pulmonary pressures at rest, congestive symptoms are elicited by exercise. In the present study, combining cardiopulmonary exercise test (CPET) with echocardiography, we aimed to evaluate the presence of exercise-induced pulmonary hypertension (EiPAH) its role in functional limitation and its prognostic significance in a cohort of patients with obstructive and non-obstructive HCM. Methods and results 182 HCM patients (35% females, mean age 47.5 ± 15.9) undergoing CPET. During CPET, LVOT velocities and trans-tricuspid gradient were measured. Thirty-seven patients (20%) developed sPAP &gt; 40 mmHg at peak exercise (EiPAH). EiPAH was associated with an lower exercise performance, larger left atrial volumes, higher left ventricular gradient and higher VE/VCO2 slope .At multivariable model baseline sPAP (P &lt; 0.0001) and baseline left ventricular obstruction (LVOT) (P = 0.028) were significantly associated with EiPAH .Kaplan-Meier curve analysis showed EiPAH was a significant predictor of HCM –related morbidity (hazards ratio: 6.21, 95% CI: 1.47–26.19; P = 0.05; 4.21, 95% CI: 1.94–9.12; P &lt; 0.001) for the primary and the secondary endpoint respectively. Conclusions EiPAH was present in about one fifth of HCM patients without evidence of elevated pulmonary pressures at rest, and was associated with adverse clinical outcome. Diagnosing EiPAH by exercise echo/CPET may help physicians to detect early stage of PAH requiring a closer clinical monitoring and individualized treatment strategies.

Prevalence of Long COVID symptoms in Bangladesh: a prospective Inception Cohort Study of COVID-19 survivors

BackgroundThe objective of this study was to identify the prevalence of long COVID symptoms in a large cohort of people living with and affected by long COVID and identify any potential associated risk factors.MethodsA prospective survey was undertaken of an inception cohort of confirmed people living with and affected by long COVID (aged 18–87 years). 14392 participants were recruited from 24 testing facilities across Bangladesh between June and November 2020. All participants had a previously confirmed positive COVID-19 diagnosis, and reported persistent symptoms and difficulties in performing daily activities. Participants who consented were contacted by face-to-face interview, and were interviewed regarding long COVID, and restriction of activities of daily living using post COVID-19 functional status scale. Cardiorespiratory parameters measured at rest (heart rate, systolic blood pressure, diastolic blood pressure, oxygen saturation levels, maximal oxygen consumption, inspiratory and expiratory lung volume) were also measured.ResultsAmong 2198 participants, the prevalence of long COVID symptoms at 12 weeks was 16.1%. Overall, eight long COVID symptoms were identified and in descending order of prominence are: fatigue, pain, dyspnoea, cough, anosmia, appetite loss, headache and chest pain. People living with and affected by long COVID experienced between 1 and 8 long COVID symptoms with an overall duration period of 21.8±5.2 weeks. Structural equation modelling predicted the length of long COVID to be related to younger age, female gender, rural residence, prior functional limitation and smoking.ConclusionIn this cohort, at 31 weeks post diagnosis, the prevalence of long COVID symptoms was 16.1%. The risk factors identified for presence and longer length of long COVID symptoms warrant further research and consideration to support public health initiatives.